KAS Speakers Bureau
Thank you for your interest in participating as a volunteer in the Kentucky Science Speakers' Bureau. We look forward to helping you share your expertise with others around Kentucky! Please tell us about your areas of expertise and what kinds of speaking engagements you are willing to consider. The broader your responses are, the more likely we are to find opportunities for you! This information will ultimately be available to visitors to the KAS website who are looking for science experts. Please share information that you are comfortable having publicly available, including your preferred contact information.
1. First Name
Your answer
2. Last Name
Your answer
3. Organization / Affiliation
Your answer
4. Email
Your answer
5. Phone Numbers
Work:
Your answer
Cell:
Your answer
Other:
Your answer
6. The best way to contact me is...
7. City
Your answer
8. Which county do you live in?
Your answer
9. Zip Code
Your answer
10. I understand that I may not be compensated for speaking engagements arranged through the KAS Speakers Bureau, but that if compensation is offered in the form of an honorarium or expenses reimbursement , it is to be negotiated between the speaker and the requester. I understand that I am responsible for negotiating the terms of that compensation in accordance with the policies of my own employer or institution and that KAS is not a mediator in the discussions about compensation.
11. Which Best Describes you?
12. Are you a member of the Kentucky Academy of Science? If not, please join at: http://kyacademyofscience.net/membership/join/
13. Which general topic area best describes your expertise?
Required
14. How would you describe your scientific expertise or research interest?
Your answer
15. List any specific topics about which you prefer to present
Your answer
16. List any specific talks you prefer to give
Your answer
17. Next Generation Science Standards emphasize the scientific process and practice. Are you available to present hands-on science programs? If you have experience with this please provide an example:
Your answer
18. Please list your degrees and corresponding institutions:
Bachelor's:
Your answer
Master's:
Your answer
PhD:
Your answer
Other
Your answer
19. How long would you consider traveling for a speaking engagement?
Comments:
Your answer
20. For which of the following types of audiences would you consider speaking or presenting? Would you consider presenting for
21. Would you participate in ongoing mentoring of a science teacher?
22. What size of group are you comfortable speaking or presenting for? (check all that apply)
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms